By JANE DUNBAR
You're a woman in your mid-30s. You're pregnant, and you're worried that at your age the chances increase of your baby having abnormalities. What do you do? As the average age of New Zealand women giving birth steadily rises, this question is faced by an increasing number of women every year. And, as technologies have emerged, the choices of action have expanded.
The biggest addition to the arsenal of pre-natal screening is the nuchal-fold scan - a safe, non-invasive, pain-free test that gives you information on your odds of having a healthy baby. Unlike most other tests, it gives you the information early in the pregnancy, providing valuable decision-making time if problems are detected.
Experts say the technology has been used in New Zealand for some years, but only now have the scans become widely available.
When I was pregnant in Wellington 18 months ago, no one mentioned the possibility of a nuchal scan. On holiday with a friend in London, however, I discovered I could get a scan done at a clinic there.
A nuchal scan uses ultrasound, between 10 and 14 weeks into the pregnancy, to get a measurement at the back of the baby's neck. An unusually thick measurement can indicate a greater likelihood of Down's Syndrome and
other chromosomal or cardiac abnormalities.
In my case, the measurement fell within the normal range, which changed my risk of having a Down's Syndrome baby from 1-in-260 to 1-in-1300. While the results did not tell me anything with certainty, it changed the odds to such a degree that I abandoned the idea of having amniocentesis.
For weeks I had been deciding whether to have an amnio. This test can give you definitive information but it is an invasive procedure that carries a slight risk of miscarriage. While I was anxious about my age meaning I was more likely to have a child with disabilities, I found the idea that the amnio could cause me to lose the baby equally disturbing. The nuchal scan was a wonderful compromise - no certainty, but much reassurance from the adjusted assessment of risk.
For some people, information about the health of the baby is irrelevant, even offensive. There is no point in exploring the question of abnormalities because, for them, termination of pregnancies
is out of the question. There are also those who find the whole quest for "normal" children abhorrent, a slur on the value of children who are born with disabilities.
But for me, and many like me, we want information, and we want to be able to make choices. Developments such as the use of nuchal scans are important to us. The future of nuchal testing in New Zealand, however, is not clear. Whereas in London, pregnant women are automatically offered a nuchal scan, it is a long way from being routine practice in this country.
Auckland radiologist Dr Robert Sim is on a Health Funding Authority committee looking at the ethics and financing of nuchal scans.
While Sim is an advocate of nuchal testing and believes it should be available as a choice for women, he says continued funding is a vexed question.
"You have to work out how much as a country you're prepared to spend on screening for conditions," he says.
Also on the committee is the head of radiology at Christchurch Women's Hospital, Dr Nigel Anderson, who says there has been a "huge surge" in the use of nuchal testing, but the case for routine tests in all pregnancies is far from clear.
Both men believe there should be wider debate about the advantages and disadvantages of increased screening, including medical, ethical and economic issues.
Family scanning
AdvertisementAdvertise with NZME.